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Cardiovascular Conditions Flashcards

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1
Q

What is atherosclerosis?

A

A combination of atheromas (fatty deposits in artery walls) and sclerosis (the process of hardening or stiffening of the blood vessel walls) affecting medium and large arteries.

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2
Q

What causes atherosclerosis?

A

Chronic inflammation and activation of the immune system in the arteries wall causing deposition of lipids the the artery wall.

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3
Q

Atherosclerosis Risk Factors

A 
Old Age
Family History
Male
Smoking
High alcohol consumption
Poor Diet
Low Exercise
Obesity
Poor Sleep
Stress
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4
Q

Medical Co-morbidities Associated

A 
Diabetes
Hypertension
Chronic Kidney Disease
Rheumatoid Arthritis
Atypical Antipsychotic Medications
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5
Q

What is aortic regurgitation?

A

a condition in which there is inadequate closure of the aortic valve during cardiac diastole, leading to the leakage of blood from the aorta into the left ventricle

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6
Q

Signs and Symptoms of Aortic Regurgitation

A 
Exertional Dyspnoea
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Angina
Peripheral oedema
Fainting
Heart Murmur (soft, high-pitched, early diastolic decrescendo murmur)
Tachycardia
Palpitations
Tachypnoea
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7
Q

Causes of aortic regurgitation

A

issues with the supporting structures of the aortic root (e.g., aortic root dilation) or inadequate closure of the aortic valve leaflets during diastole(e.g., aortic root calcification). This can be either due to an impairment of the leaflets, or an increased afterload e.g., hypertension

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8
Q

Diagnosis of aortic regurgitation?

A

Echocardiogram - shows dilation of left ventricle. decreased ejection fraction and adequate systolic ejection
CXR - enlarged heart due to left ventricular hypertrophy
ECG - hypertrophy

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9
Q

Treatment of aortic regurgitation?

A

Pharmacological:
ACE inhibitors (Ramipril) and calcium channel blockers (amlodipine) to reduce afterload and relieve symptoms.
Surgery - aortic valve replacement

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10
Q

Complication of aortic regurgitation

A

Congestive heart failure if left untreated

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11
Q

What is cardiomegaly?

A

the abnormal enlargement of the entire heart, one side of the heart or a specific area (atrium or ventricles). Usually indicative of an underlying health problem

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12
Q

Causes of cardiomegaly?

A

Conditions making the heart work harder - (high blood pressure, pulmonary hypertension)
Conditions damaging heart muscle (pericarditis or coronary artery disease)
Others which cause more stress on the heart - anaemia, hypothyroidism, hyperthyroidism

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13
Q

Signs and Symptoms of cardiomegaly?

A 
Shortness of breath
Fatigue
Abnormal Rhythm
Chest pain
Peripheral oedema
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14
Q

Diagnosis of cardiomegaly?

A

CXR - shows enlarged heart
Echocardiogram and ECG used to help find the cause
Blood tests

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15
Q

Non-Pharmacological treatments for cardiomegaly?

A

Lifestyle modifications to decrease risk factors such as smoking cessation, healthy diet, increase exercise, decreasing alcohol consumption

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16
Q

Pharmacological treatment for cardiomegaly?

A 
Statins to reduce cholesterol (Coronary Artery Disease) and aspirin
ACE inhibitors (high blood pressure)
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17
Q

Complications of cardiomegaly?

A

Blood clots and heart failure

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18
Q

What is Deep Vein Thrombosis (DVT)?

A

when a blood clot, or thrombus, develops in one of the large veins of the upper or lower limbs

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19
Q

Causes of DVTs?

A

Virchow’s triad, which includes hypercoagulability, slowed venous blood flow, and damage to the inner lining of blood vessels.
Hypercoagulability - due to genetic conditions, such as with factor V Leiden or with antithrombin III deficiency, or due to acquired reasons, such as after a surgery or when taking certain medications
Slowed venous blood flow - can happen during long periods of inactivity, such as with prolonged bed rest, long flights and car rides, and during pregnancy
Damage to vessels - caused by some kind of trauma or injury; atherosclerosis; infections; chronic inflammation; or toxins, like those found in tobacco cigarettes

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20
Q

Signs and Symptoms of DVT?

A

Redness
Swelling
Pain in affected limb

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21
Q

Diagnosis of DVT?

A

D-dimer blood test
Physical Examination
Wells Score

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22
Q

Treatment of DVT?

A

Blood thinners e.g., heparin, warfarin or direct anticoagulants e.g., rivaroxaban

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23
Q

Prevention of DVT?

A

Compression stockings and doing frequent calf exercises

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24
Q

Complications of DVT?

A

Pulmonary Embolism

Venous thromboembolism

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25
What is unstable angina?
A type of angina pectoris that is unpredictable and classified as an acute coronary syndrome
26
Causes of unstable angina
Usually caused by ruptured atherosclerotic plaque or formation of thrombosis on top of plaque causing almost complete blockage of blood vessel
27
Signs and symptoms of unstable angina
Pain characterised as a pressure, squeezing, burning and tightness radiating to jaw, arms, shoulder and back which lasts for no more than 20 minutes Dyspnea Fatigue Nausea
28
Diagnosis of unstable angina
Serial troponins measured to rule out MI | ECG can present with ST segment depression and T wave inversions
29
Treatment of unstable angina
Clopidogrel, low molecular weight heparin (LMWH), Enoxaparin
30
What is a myocardial infarction?
Death of heart muscle cells due to lack of oxygen rich blood flow
31
Causes of MI
Plaque buildup forming in the lumen | Blood platelets adhere to plaque and enhance clotting process, creating a blockage
32
Types of MI
STEMI - coronadt artery completely blocked. ECG shows ST elevation, possible Q waves NSTEMI - coronary artery not completely blocked. ECG shows ST depression
33
Risk factors for MI
``` Old age Smoking High blood pressure Diabtetes High cholesterol Low levels of exercise Obesity Alcohol consumption Illegal drug use Chronic stress Family history Male ```
34
Complications of MI
``` DARTH VADER Death Arrythmia Rupture Tamponade Heart Failure Valve disease Aneurysm of ventricles Dressler’s syndrome Embolism Recurrence/Regurgitation ```
35
Signs and Symptoms of MI
``` Acute chest pain radiating to arm/jaw Feeling of fullness/indigestion Dyspnea Fatigue Nausea ```
36
Diagnosis of MI
Troponin - rise apparent within 2-4hrs, peaking ~24hrs CK-MB - detects reinfarction after initial MI - levels increased 4 hrs after infarction ECG: <30 mins - ST segment elevation (STEMI) or ST depression (NSTEMI) <24hrs - T wave inversion >24hrs - Q waves appear
37
Treatment of MI
Percutaneous Coronary Intervention (PCI) NSTEMI less time sensotive than STEMI Control symptoms with morphine and nitroglycerin Heparin, aspirin + clopidogrel, beta blockers, ACE Inhibitors, statins
38
What is peripheral artery disease?
Narrowing of the arteries in peripheral, non-coronary arterial circulation. Decreased blood flow causes arterial insufficiency which leads to tissue ischaemia
39
Risk factors for peripheral arterial disease
``` Smoking High BP Diabetes Hyperlipidaemia Metabolic syndrome Age>60 Obesity Increased risk in people of African descent ```
40
Complications of peripheral artery disease
Pain Tissue necrosis Amputation Increased risk of developing coronary artery disease
41
Signs and symptoms of peripheral artery disease
Asymptomatic until significant occlusion develops Intermittent claudication - muscle pain due to increased oxygen demand and decreased supply Decreased peripheral pulses Leg/foot ulcers that do not heal properly Colour changes Cool dry shiny hairless skin
42
Signs of acute limb ischaemia
``` Pain Pallor Pulselessness Paresthesia Paralysis ```
43
Diagnosis of peripheral artery disease
Doppler ultrasound - decreased blood flow | Auscultation- bruit heard in suspected artery
44
Treatment of peripheral artery disease
Antiplatelet therapy Surgery - angioplasty, stent insertion, bypass surgery, amputation Modify risk factors Wound care
45
What is aortic dissection?
Tearing/widening of artery’s internal layer followed by blood entering vessel wall causing pain
46
Types of aortic dissection
Type A : dissection involves ascending aorta and/or aortic arch, sometimes descending aorta Type B: dissection involves descending aorta/aortic arch without involvement of ascending aorta
47
Causes of aortic dissection
Weakness in vessel wall due to chronic hypertension, blood vessel coarctation, connective tissue disorders, aneurysms
48
Risk factors of aortic dissection
``` Pregnancy Previous open heart surgery Vasculitis Trauma Family history Turner’s syndrome Cocaine use ```
49
Complications of Aortic Dissection
Pericardial tamponade | Obstruction of arterial branches off aorta leading to ischaemia of individual organs
50
Signs and symptoms of aortic dissection
``` Sudden, intense, tearing chest pain radiating to back Nausea Vomiting Decreased peripheral pulses Asymmetric pulses Diastolic decrescendo murmur ```
51
Diagnosis of aortic dissection
CXR - widening of mediastinum Transesophageal echocardiogram- high sensitivity for identifying dissection and complications CT angiography ECG - Helps rule out alternative diagnostic possibilities
52
Treatment of aortic dissection (Medications)
First line - beta blockers Second line - calcium channel blockers Pain management Surgical repair if necessary
53
What is vasculitis?
Inflammation of blood vessels
54
Causes of vasculitis?
Damaged endothelium | Autoimmune disease
55
Signs and symptoms of vasculitis
``` Fever Weight loss Malaise Fatigue Ischaemia - blood cells clump together and fibrin deposits in vessel wall restrict blood flow ```
56
Diagnosis of vasculitis
C-reactive protein (CRP) Erythrocyte sedimentation rate (ESR) Complete blood count Biopsy vessel segment
57
Treatment of vasculitis
Corticosteroids/immunosuppressive drugs to reduce inflammatory response
58
What is hypertension?
Condition in which blood pressure not regulated correctly resulting in elevated blood pressure over 140/90mmHg
59
Types of hypertension
Primary hypertension | Secondary hypertension - due to other conditions
60
Risk Factors of primary hypertension
``` Age Male Obesity Stress Sedentary lifestyle Family history Excess sodium and alcohol intake High cholesterol ```
61
Complications of hypertension
``` Increased risk of atherosclerosis Loss of arterioles Coronary artery disease Left ventricular hypertrophy Atrial fibrillation Stroke Retinopathy Aortic dissection ```
62
Signs and symptoms of hypertension
Vast majority are asymptomatic Headaches Dyspnea
63
Diagnosis of hypertension
Non-invasive blood pressure monitoring
64
Treatment of blood pressure (non pharmacological)
``` Low sodium diet Exercise Quit smoking Limit alcohol Maintain healthy weight ```
65
Pharmacological Treatment for patients aged 55 or over or african caribbean descent
Calcium Channel Blocker e.g., amlodipine Then ACEI or ARB Then thiazide like diuretic Then low dose spironolactone or beta blocker
66
Pharmacological treatment of patients with type 2 diabetes or aged under 55
ACEI or ARB Then CCB Then thiazide like diuretics Then low dose spironolactone or beta blocker
67
What is familial hypercholesterolemia?
Autosomal dominant disorder that causes increased LDL leading to early onset atherosclerotic disease
68
What is hyperlipidemia?
Increased serum total cholesterol and LDL
69
Causes of hyperlipidemia?
Primary - genetic abnormalities or defective apoprotein B | Secondary - Cushing Syndrome, excessive alcohol intake, uncontrolled diabetes mellitus, certain drugs
70
Risk Factors of hyperlipidemia
Genetic predisposition Diet/other lifestyle factors Pregnancy Male
71
Complications of hyperlipidemia
Cardiovascular disease Cerebrovascular disease Peripheral vascular disease
72
Signs and symptoms of hyperlipidemia
Corneal arcus | Xanthomas
73
Diagnosis of hyperlipideamia
Physical examination - presence of risk factors and cardiovascular disease symptoms Fasting lipid profile - increased total cholesterol, increased triglycerides, increased LDL and decreased HDL
74
Treatment of hyperlipidemia
Statin therapy
75
What is atrial fibrillation?
Rapid, irregular heart rate
76
Causes
Regular impulses of sinus node overwhelmed by rapid electrical discharges from various sources
77
Risk Factors of atrial fibrillation
``` Old age Obesity Diabetes Excessive alcohol consumption Coronary artery disease Cardiovascular disease Lung disease Hyperthyroidism ```
78
Complications of atrial fibrillation
Thromboembolic events Heart failure Hypotensive shock Stroke
79
Signs and symptoms of atrial fibrillation
``` May be asymptomatic Dyspnea Fatigue Palpatations Lightheadedness Weakness Chest pain ```
80
Diagnosis of atrial fibrillation
ECG - absent P waves, irregularly timed QRS complexes | Echocardiogram
81
Rate control of atrial fibrillation
Beta blockers Non-dihydropyridine calcium channel blockers Digoxin
82
Rhythm control of atrial fibrillation
Restore sinus rhythm through cardioversion
83
Other medications for atrial fibrillation
Anticoagulants e.g., warfarin, rivaroxaban
84
What is long QT syndrome?
Cardiac rhythm disorder characterised by prolonged ventricular repolarisation
85
Types of long QT syndrome
Inherited - caused by mutations in genes associated with cardiac potassium, sodium channels. Acquired - usually caused by certain drugs
86
Risk factors for long QT syndrome
``` Electrolyte imbalances Underlying heart disease Bradyarrhythmias Biological females Old age Inherited genetic mutation Anorexia Postpartum period ```
87
Complications of long QT syndrome
Palpatations Lightheadedness Hypotension
88
Diagnosis of long QT syndrome
Serum electrolytes - hypokalemia, hypomagnesemia, hypocalcemia ECG - prolonged QT, altered T-Wave Exercise stress test Genetic testing
89
Treatment for long QT syndrome (medications)
Congenital - beta blockers, mexiletine, flecainide | Acquired - magnesium sulfate, isoproterenol, lidocaine
90
Treatment for long QT syndrome (surgery)
Congenital - implantable cardioverter-defibrillator, pacemaker Acquired - pacemaker if bradycardia triggers arrhythmia
91
What is torsades des pointes (TdP)
Where the peaks of QRS complex twist around isoelectric line on electrocardiogram
92
Risk factors of Torsades des pointes
``` LQTS Bradycardia Electrolyte imbalance Female Anorexia ```
93
Complications of tosades des pointes
Ventricular fibrillation Seizures Sudden cardiac death
94
Signs and symptoms of torsades des pointes
Palpatations Lightheadedness Syncope
95
Diagnosis of torsades des pointes
Serum electrolytes | ECG - PR interval irregular, P wave absent, QRS duration >0.12 seconds
96
Treatment of torsades des pointes
Medications - magnesium sulfate or beta blockers Surgery - left cardio-thoracic sympathectomy Treat underlying cause

1MB Cardiovascular (4 decks)

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